Acid-Base Disorders - Columbia Nephrology

1 Acid-Base DisordersJai Radhakrishnan, MD, MS2 Diagnostic Considerations Data points required:{ABG: pH, pCO2, HCO3{Chem-7 panel: anion gap Step 1: Acidemia/alkalemia (Primary disorder) Step 2: Compensation Step 3: anion gap / delta AG-delta HCO33 Step 1: Primary Disorder Alkalemia Metabolic alkalosis ( high HCO3 ) Respiratory alkalosis ( low pCO2 ) Acidemia Metabolic acidosis ( low HCO3 ) Respiratory acidosis ( high PCO2 ) 2: CompensationLIMITSLIMITS Met. alkalosisPCO2<55 Resp. alkalosisHCO3>12 Resp. acidosisHCO3<45 Met. acidosisPCO2>10 mmHgAcute/Chronic phase only with respiratory , or, more pain and suffering Metabolic acidosis {Change in PaCO2 = x change in HCO3- Metabolic alkalosis {Change in PaCO2 = x change in HCO3 Acute respiratory acidosis {Change in HCO3- = x change in PaCO2 Chronic respiratory acidosis {Change in HCO3- = x change in PaCO2 Acute respiratory alkalosis {Change in HCO3- = x change in PaCO2 Chronic respiratory alkalosis {Change in HCO3- = x change in PaCO2 *A positive or negative change represents an increase or decrease, respectively, from the normal value of 40 mm Hg for PaCO2 or 24 mEq/L for HCO3.}}}}}}}}

30 Comparison of Normal Anion-Gap Acidoses Finding Type 1 RTA Type 2 RTA Type 4 RTA GI Bicarbonate Normal anion-gap acidosis Yes Yes Yes Yes Loss

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  Base, Disorders, Acid, Anions, Acid base disorders, Anion gap

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